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Vitamin D Deficiency: Defining, Prevalence, Causes, and Strategies of Addressing

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Abstract

There are variable definitions of vitamin D deficiency, based on different thresholds of serum 25-hydroxyvitamin D (25(OH)D); this has a major bearing on the prevalence estimates of vitamin D deficiency and consequently on the magnitude of the public health issue of low vitamin D status. Despite this, there is widespread acknowledgement of the presence of vitamin D deficiency, even using the most conservative serum 25(OH)D threshold of < 25/30 nmol/L, in both low- and high-income country setting and the pressing need to address this deficiency. While ultraviolet B-rich sunlight stimulates synthesis of vitamin D in skin, there are environmental factors and personal characteristics which prevent or impede such dermal synthesis. There are several complexities and concerns in advocating sun exposure as a public health approach for increasing vitamin D status. This places increased emphasis on addressing vitamin D deficiency through dietary means. However, naturally rich sources of vitamin D are few and infrequently consumed, and nutrition surveillance data from various countries have indicated that habitual vitamin D intakes in the population are much lower than the recommendations. There are a number of strategies that can be considered for the control of micronutrient malnutrition, these include (i) increasing the diversity of foods consumed, (ii) food fortification, and (iii) supplementation. The present narrative review will consider these strategies for addressing low dietary vitamin D intake and consequently lowering the risk of vitamin D deficiency.

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References

  1. Seamans KM, Cashman KD (2009) Existing and potentially novel functional markers of vitamin D status: a systematic review. Am J Clin Nutr 89:1997S–2008S

    CAS  PubMed  Google Scholar 

  2. Institute of Medicine (2011) Dietary reference intakes for calcium and vitamin D. The National Academies Press, Washington, D.C.

    Google Scholar 

  3. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine Society (2011) Evaluation, treatment, and prevention of vitamin d deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930

    CAS  PubMed  Google Scholar 

  4. Scientific Advisory Committee on Nutrition (2016) Report on Vitamin D and Health. http://www.sacn.gov.uk/pdfs/sacn_vitaminD_and_health_report_web.pdf. Accessed July 1, 2016

  5. Cashman KD, van den Heuvel EG, Schoemaker RJ, Prévéraud DP, Macdonald HM, Arcot J (2017) 25-Hydroxyvitamin D as a biomarker of vitamin D status and Its modeling to inform strategies for prevention of vitamin D deficiency within the population. Adv Nutr 8:947–957

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Weaver CM, Fleet JC (2004) Vitamin D requirements: current and future. Am J Clin Nutr 80:1735S–1739S

    CAS  PubMed  Google Scholar 

  7. EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies) (2016) Scientific opinion on dietary reference values for vitamin D. EFSA J. https://doi.org/10.2903/j.efsa.2016

    Article  Google Scholar 

  8. Braegger C, Campoy C, Colomb V, Decsi T, Domellof M, Fewtrell M, Hojsak I, Mihatsch W, Molgaard C, Shamir R et al (2013) Vitamin D in the healthy European paediatric population. J Pediatr Gastroenterol Nutr 56:692–701

    CAS  PubMed  Google Scholar 

  9. Munns CF, Shaw N, Kiely M et al (2016) Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab 101:394–415

    CAS  PubMed  PubMed Central  Google Scholar 

  10. NORDEN Nordic Nutrition Recommendations (2013), 5th Edition (NNR5)—Vitamin D. http://www.slv.se/en-gb/Startpage-NNR/Public-consultation11/. Accessed August 2013

  11. German Nutrition Society (2012) New reference values for vitamin D. Ann Nutr Metab 60:241–246

    Google Scholar 

  12. Cashman KD (2018) Vitamin D requirements for the future-lessons learned and charting a path forward. Nutrients. https://doi.org/10.3390/nu10050533

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sempos CT, Vesper HW, Phinney KW, Thienpont LM, Coates PM, Vitamin D Standardization Program (VDSP) (2012) Vitamin D status as an international issue: national surveys and the problem of standardization. Scand J Clin Lab Invest Suppl 243:32–40

    PubMed  Google Scholar 

  14. Schleicher RL, Sternberg MR, Looker AC, Yetley EA, Lacher DA, Sempos CT, Taylor CL, Durazo-Arvizu RA, Maw KL, Chaudhary-Webb M et al (2016) National estimates of serum total 25-hydroxyvitamin D and metabolite concentrations measured by liquid chromatography-tandem mass spectrometry in the US Population during 2007-2010. J Nutr 146:1051–1061

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Sarafin K, Durazo-Arvizu R, Tian L, Phinney KW, Tai S, Camara JE, Merkel J, Green E, Sempos CT, Brooks SP (2015) Standardizing 25-hydroxyvitamin D values from the Canadian Health Measures Survey. Am J Clin Nutr 102:1044–1050

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Cashman KD, Dowling KG, Škrabáková Z, Gonzalez-Gross M, Valtueña J, De Henauw S, Moreno L, Damsgaard CT, Michaelsen KF, Mølgaard C et al (2016) (2016) Vitamin D deficiency in Europe—Pandemic? Am J Clin Nutr 103:1033–1044

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Rabenberg M, Scheidt-Nave C, Busch MA, Thamm M, Rieckmann N, Durazo-Arvizu RA, Dowling KG, Škrabáková Z, Cashman KD, Sempos CT, Mensink GBM (2018) Implications of standardization of serum 25-hydroxyvitamin D data for the evaluation of vitamin D status in Germany, including a temporal analysis. BMC Public Health 18:845

    PubMed  PubMed Central  Google Scholar 

  18. National Diet and Nutrition Survey (NDNS) rolling program. https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined. Accessed Dec 14, 2018

  19. Manios Y, Moschonis G, Lambrinou CP, Tsoutsoulopoulou K, Binou P, Karachaliou A, Breidenassel C, Gonzalez-Gross M, Kiely M, Cashman KD (2018) A systematic review of vitamin D status in southern European countries. Eur J Nutr 57(6):2001–2036

    CAS  PubMed  Google Scholar 

  20. Brooks SPJ, Greene-Finestone L, Whiting S, Fioletov VE, Laffey P, Petronella N (2017) an analysis of factors associated with 25-hydroxyvitamin D levels in white and non-white Canadians. J AOAC Int 100:1345–1354

    CAS  PubMed  Google Scholar 

  21. Cashman KD, Dowling KG, Škrabáková Z, Kiely M, Lamberg-Allardt C, Durazo-Arvizu RA, Sempos CT, Koskinen S, Lundqvist A, Sundvall J, Linneberg A, Thuesen B, Husemoen LL, Meyer HE, Holvik K, Grønborg IM, Tetens I, Andersen R (2015) Standardizing serum 25-hydroxyvitamin D data from four Nordic population samples using the Vitamin D Standardization Program protocols: shedding new light on vitamin D status in Nordic individuals. Scand J Clin Lab Invest 75:549–561

    CAS  PubMed  Google Scholar 

  22. Hayes A, Cashman KD (2017) Food-based solutions for vitamin D deficiency: putting policy into practice and the key role for research. Proc Nutr Soc 76:54–63

    PubMed  Google Scholar 

  23. Cashman KD, Sheehy T, O’Neill CM (2018) Is vitamin D deficiency a public health concern for low middle income countries? A systematic literature review. Eur J Nutr. https://doi.org/10.1007/s00394-018-1607-3

    Article  PubMed  Google Scholar 

  24. Roth DE, Abrams SA, Aloia J, Bergeron G, Bourassa MW, Brown KH, Calvo MS, Cashman KD, Combs G, De-Regil LM, Jefferds ME, Jones KS, Kapner H, Martineau AR, Neufeld LM, Schleicher RL, Thacher TD, Whiting SJ (2018) Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann NY Acad Sci 1430:44–79

    CAS  PubMed  Google Scholar 

  25. Index Mondeo. India Demographics Profile 2018. https://www.indexmundi.com/india/demographics_profile.html. Accessed Dec 5, 2018

  26. Kimlin MG (2008) Geographic location and vitamin D synthesis. Mol Aspects Med 29:453–461

    CAS  PubMed  Google Scholar 

  27. O’Neill CM, Kazantzidis A, Ryan MJ, Barber N, Sempos CT, Durazo-Arvizu RA, Jorde R, Grimnes G, Eiriksdottir G, Gudnason V, et al. (2016) Seasonal changes in vitamin D-effective UVB availability in Europe and associations with population serum 25-hydroxyvitamin D. Nutrients 30:8(9)

    PubMed Central  Google Scholar 

  28. Webb AR (2006) Who, what, where and when-influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol 92:17–25

    CAS  PubMed  Google Scholar 

  29. Matsuoka LY, Wortsman J, Haddad JG, Kolm P, Hollis BW (1991) Racial pigmentation and the cutaneous synthesis of vitamin D. Arch Dermatol 127:536–538

    CAS  PubMed  Google Scholar 

  30. Holick MF (2008) Deficiency of sunlight and vitamin D. BMJ 336:1318–1319

    PubMed  PubMed Central  Google Scholar 

  31. Kiely M, Black LJ (2012) Dietary strategies to maintain adequacy of circulating 25-hydroxyvitamin D concentrations. Scand J Clin Lab Invest Suppl 243:14–23

    PubMed  Google Scholar 

  32. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) (2010) Scientific opinion on principles for deriving and applying dietary reference values. EFSA J 8:1458. [30 pp.]. www.efsa.europa.eu

  33. Fulgoni VL, Keast DR, Bailey RL, Dwyer J (2011) Foods, fortificants, and supplements: where do Americans get their nutrients? J Nutr 141:1–8

    Google Scholar 

  34. Vatanparast H, Calvo MS, Green TJ, Whiting SJ (2010) Despite mandatory fortification of staple foods, vitamin D intakes of Canadian children and adults are inadequate. J Steroid Biochem Mol Biol 121:301–303

    CAS  PubMed  Google Scholar 

  35. Roman Viñas B, Ribas Barba L, Ngo J, Gurinovic M, Novakovic R, Cavelaars A, de Groot LC, van’t Veer P, Matthys C, Serra Majem L (2011) Projected prevalence of inadequate nutrient intakes in Europe. Ann Nutr Metab 59:84–95

    PubMed  Google Scholar 

  36. Black LJ, Walton J, Flynn A, Cashman KD, Kiely M (2015) Small increments in vitamin D intake by irish adults over a decade show that strategic initiatives to fortify the food supply are needed. J Nutr 145:969–976

    CAS  PubMed  Google Scholar 

  37. Reid D, Toole BJ, Knox S, Talwar D, Harten J, O’Reilly DS, Blackwell S, Kinsella J, McMillan DC, Wallace AM (2011) The relation between acute changes in the systemic inflammatory response and plasma 25-hydroxyvitamin D concentrations after elective knee arthroplasty. Am J Clin Nutr 93:1006–1011

    CAS  PubMed  Google Scholar 

  38. Vimaleswaran KS, Berry DJ, Lu C, Tikkanen E, Pilz S, Hiraki LT, Cooper JD, Dastani Z, Li R, Houston DK, Wood AR et al (2013) Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med. 10(2):e1001383

    PubMed  PubMed Central  Google Scholar 

  39. Cashman KD (2012) The role of vitamers and dietary-based metabolites of vitamin D in prevention of vitamin D deficiency. Food Nutr Res. https://doi.org/10.3402/fnr.v56i0.5383

    Article  PubMed  PubMed Central  Google Scholar 

  40. Matsuoka LY, Wortsman J, Haddad JG, Hollis BW (1989) In vivo threshold for cutaneous synthesis of vitamin D3. J Lab Clin Med 114:301–305

    CAS  PubMed  Google Scholar 

  41. Young AR, Greenaway J, Harrison GI, Lawrence KP, Sarkany R, Douki T, Boyer F, Josse G, Questel E, Monteil C, Rossi AB (2018) Sub-optimal application of a high SPF sunscreen prevents epidermal DNA damage in vivo. Acta Derm Venereol 98:880–887

    CAS  PubMed  Google Scholar 

  42. Webb AR, Kazantzidis A, Kift RC, Farrar MD, Wilkinson J, Rhodes LE (2018) Colour Counts: sunlight and Skin Type as Drivers of Vitamin D Deficiency at UK Latitudes. Nutrients 10:E457

    PubMed  Google Scholar 

  43. Allen L, de Benoist B, Dary O, Hurrell R (2006) Guidelines on food fortification with micronutrients. World Health Organization and Food and Agriculture Organization of the United Nations. Geneva. http://apps.who.int/iris/bitstream/10665/43412/1/9241594012_eng.pdf. Accessed June 28, 2016)

  44. Cashman KD, Ritz C, Kiely M, Collaborators Odin (2017) Improved dietary guidelines for vitamin D: application of individual participant data (IPD)-level meta-regression analyses. Nutrients 9(5):E469

    PubMed  Google Scholar 

  45. Department of Health (1991) Dietary Reference Values for food energy and nutrients for the United Kingdom. London: Her Majesty’s Stationery Office (Report on Health and Social Subjects; 41]

  46. Health Council of the Netherlands (2012) Evaluation of dietary reference values for vitamin D, health council of the Netherlands, The Hague, (publication no. 2012/15E)

  47. Calvo MS, Whiting SJ (2006) Public health strategies to overcome barriers to optimal vitamin D status in populations with special needs. J Nutr 136:1135–1139

    CAS  PubMed  Google Scholar 

  48. Cranney A, Horsley T, O’Donnell S, Weiler H, Puil L, Ooi D, Atkinson S, Ward L, Moher D, Hanley D, Fang M, Yazdi F, Garritty C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V (2007) Effectiveness and safety of vitamin D in relation to bone health. Effectiveness and safety of vitamin D in relation to bone health. Agency for Healthcare Research and Quality, Rockville

    Google Scholar 

  49. Autier P, Gandini S, Mullie P (2012) A systematic review: influence of vitamin D supplementation on serum 25-hydroxyvitamin D concentration. J Clin Endocrinol Metab 97:2606–2613

    CAS  PubMed  Google Scholar 

  50. Aloia JF, Patel M, Dimaano R, Li-Ng M, Talwar SA, Mikhail M, Pollack S, Yeh JK (2008) Vitamin D intake to attain a desired serum 25-hydroxyvitamin D concentration. Am J Clin Nut 87:1952–1958

    CAS  Google Scholar 

  51. Whiting SJ, Langlois KA, Vatanparast Greene-Finestone LS (2011) The vitamin D status of Canadians relative to the 2011 Dietary Reference Intakes: an examination in children and adults with and without supplement use. Am J Clin Nutr 94:128–135

    CAS  PubMed  Google Scholar 

  52. Bailey RL, Dodd KW, Goldman JA, Gahche JJ, Dwyer JT, Moshfegh AJ, Sempos CT, Picciano MF (2010) Estimation of total usual calcium and vitamin D intakes in the United States. J Nutr 140:817–822

    CAS  PubMed  PubMed Central  Google Scholar 

  53. Rooney MR, Harnack L, Michos ED, Ogilvie RP, Sempos CT, Lutsey PL (2017) Trends in Use of High-Dose Vitamin D Supplements Exceeding 1000 or 4000 International Units Daily, 1999-2014. JAMA 317:2448–2450

    PubMed  PubMed Central  Google Scholar 

  54. Cashman KD, Kiely M (2017) Vitamin D and food fortification. In: Vitamin D, 4th Edition. (Editors: David Feldman J. Wesley Pike, Roger Bouillon, Edward Giovannucci, David Goltzman and Martin Hewison). Elsevier

  55. Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC (2010) Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 303:1815–1822

    CAS  PubMed  Google Scholar 

  56. Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ, Staehelin HB, Meyer OW, Theiler R, Dick W, Willett WC, Egli A (2016) Monthly high-dose vitamin D treatment for the prevention of functional decline: a randomized clinical trial. JAMA Intern Med 176:175–183

    PubMed  Google Scholar 

  57. Food Standards Agency, UK (2008) McCance and Widdowson’s Composition of Foods integrated dataset. http://www.food.gov.uk/science/dietarysurveys/dietsurveys/. Accessed June 1, 2011

  58. FAOSTAT (2017) Food balance sheets.http://faostat.fao.org/site/368/default.aspx. Accessed Dec 14, 2018

  59. GAIN. https://www.gainmarketplace.com/rwanda/news/marketplace-rwanda-improving-environments-availability-poultry-products-low-income. Accessed Dec 14, 2018

  60. Shakur YA, Lou W, L’Abbe MR (2014) Examining the effects of increased vitamin D fortification on dietary inadequacy in Canada. Can J Public Health 105:e127–e132

    PubMed  PubMed Central  Google Scholar 

  61. Calvo MS, Whiting SJ, Barton CN (2004) Vitamin D fortification in the United States and Canada: current status and data needs. Am J Clin Nutr 80:1710S–1716S

    CAS  PubMed  Google Scholar 

  62. Calvo MS, Whiting SJ (2013) Survey of current vitamin D food fortification practices in the United States and Canada. J Steroid Biochem Mol Biol 136:211–213

    CAS  PubMed  Google Scholar 

  63. US Food and Drug Administration (2016). Food Additives Permitted for Direct Addition to Food for Human Consumption; Vitamin D2 and Vitamin D3. Federal Register Volume 81, Number 137 (Monday, July 18, 2016)]. http://regulations.justia.com/regulations/fedreg/2016/07/18/2016-16738.html. Accessed Aug 8, 2016

  64. Black LJ, Seamans KM, Cashman KD, Kiely M (2012) An updated systematic review and meta-analysis of the efficacy of vitamin D food fortification. J Nutr 142:1102–1108

    CAS  PubMed  Google Scholar 

  65. O’Donnell S, Cranney A, Horsley T, Weiler HA, Atkinson SA, Hanley DA, Ooi DS, Ward L, Barrowman N, Fang M, Sampson M, Tsertsvadze A, Yazdi F (2008) Efficacy of food fortification on serum 25-hydroxyvitamin D concentrations: systematic review. Am J Clin Nutr 88:1528–1534

    PubMed  Google Scholar 

  66. Manios Y, Moschonis G, Mavrogianni C, van den Heuvel E, Singh-Povel CM, Kiely M, Cashman KD (2017) Reduced-fat Gouda-type cheese enriched with vitamin D3 effectively prevents vitamin D deficiency during winter months in postmenopausal women in Greece. Eur J Nutr 56:2367–2377

    CAS  PubMed  Google Scholar 

  67. Kazmi SA, Vieth R (2007) Rousseau, D. Vitamin D3 fortification and quantification in processed dairy products. Int Dairy J 17:753–759

    CAS  Google Scholar 

  68. Langlois K, Greene-Finestone L, Little J, Hidiroglou N, Whiting S (2011) Vitamin D status of Canadians as measured in the 2007 to 2009. Can Health Meas Survey Health Rep 21:47–55

    Google Scholar 

  69. El-Hayek J, Pham TT, Finch S, Hazell TJ, Jean-Philippe S, Vanstone CA, Agellon S, Rodd C, Rauch F, Weiler HA (2013) Vitamin D status in montreal preschoolers is satisfactory despite low vitamin D intake. J Nutr 143:154–160

    CAS  PubMed  Google Scholar 

  70. Canada Gazette (2018). Regulations amending certain regulations made under the food and drugs act (nutrition symbols, other labelling provisions, partially hydrogenated oils and vitamin D) Vol. 152, No. 6. http://www.gazette.gc.ca/rp-pr/p1/2018/2018-02-10/html/reg2-eng.html. Accessed Feb 10, 2018

  71. Tylavsky FA, Cheng S, Lyytikainen A, Viljakainen H, Lamberg-Allardt C (2006) Strategies to improve vitamin D status in northern European children: exploring the merits of vitamin D fortification and supplementation. J Nutr 136:1130–1134

    CAS  PubMed  Google Scholar 

  72. Helldan A, Raulio S, Kosola M, Tapanainen H, Ovaskainen ML, Smith S (2013) The National FINDIET 2012 Survey. ISBN 978-952-245-950-3 (painettu); 978-952-245-951-0 (verkko) THL. Raportti 16/2013, 187 s. Helsinki (2013)

  73. Raulio S, Erlund I, Männistö S, Sarlio-Lähteenkorva S, Sundvall J, Tapanainen H, Vartiainen E, Virtanen SM (2017) Successful nutrition policy: improvement of vitamin D intake and status in Finnish adults over the last decade. Eur. J. Public Health 27:268–273

    PubMed  Google Scholar 

  74. Jääskeläinen T, Itkonen ST, Lundqvist A, Erkkola M, Koskela T, Lakkala K, Dowling KG, Hull GL, Kröger H, Karppinen J, Kyllönen E, Härkänen T, Cashman KD, Männistö S, Lamberg-Allardt C (2017) The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data. Am J Clin Nutr 105:1512–1520

    PubMed  Google Scholar 

  75. Flynn A, Hirvonen T, Mensink GB, Ocké MC, Serra-Majem L, Stos K, Szponar L, Tetens I, Turrini A, Fletcher R, Wildemann T (2009) Intake of selected nutrients from foods, from fortification and from supplements in various European countries. Food Nutr Res. https://doi.org/10.3402/fnr.v53i0.2038

    Article  PubMed  PubMed Central  Google Scholar 

  76. Cashman KD, Kiely M (2016) Tackling inadequate vitamin D intakes within the population: fortification of dairy products with vitamin D may not be enough. Endocrine 51:38–46

    CAS  PubMed  Google Scholar 

  77. Madsen KH, Rasmussen LB, Andersen R, Mølgaard C, Jakobsen J, Bjerrum PJ, Andersen EW, Mejborn H, Tetens I (2013) Randomized controlled trial of the effects of vitamin D–fortified milk and bread on serum 25-hydroxyvitamin D concentrations in families in Denmark during winter: the Vitamin D study. Am J Clin Nutr 98:374–382

    CAS  PubMed  Google Scholar 

  78. Allen RE, Dangour AD, Tedstone AE, Chalabi Z (2015) Does fortification of staple foods improve vitamin D intakes and status of groups at risk of deficiency? A United Kingdom modeling study. Am J Clin Nutr 102:338–344

    CAS  PubMed  Google Scholar 

  79. Global Fortification Data Exchange. (2017) http://fortificationdata.org/. Accessed Dec 15, 2018

  80. Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, Garnett T, Tilman D, DeClerck F, Wood A, Jonell M, Clark M, Gordon LJ, Fanzo J, Hawkes C, Zurayk R, Rivera JA, De Vries W, Majele Sibanda L, Afshin A, Chaudhary A, Herrero M, Agustina R, Branca F, Lartey A, Fan S, Crona B, Fox E, Bignet V, Troell M, Lindahl T, Singh S, Cornell SE, Srinath Reddy K, Narain S, Nishtar S, Murray CJL (2019) Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet 393(10170):447–492

    PubMed  Google Scholar 

  81. Springmann M, Wiebe K, Mason-D'Croz D, Sulser TB, Rayner M, Scarborough P (2018) Health and nutritional aspects of sustainable diet strategies and their association with environmental impacts: a global modelling analysis with country-level detail. Lancet Planet Health 2(10):e451–e461

    PubMed  PubMed Central  Google Scholar 

  82. Clark B, Doyle J, Bull O, McClean S, Hill T (2018) Knowledge and attitudes towards vitamin D food fortification. Nutr Food Sci. https://doi.org/10.1108/NFS-04-2018-0121. Accessed Feb 26, 2019

    Google Scholar 

  83. Bromage S, Gonchigsumlaa E, Traeger M, Magsar B, Wang Q, Bater J, Li H, Ganmaa D (2019) Awareness and attitudes regarding industrial food fortification in mongolia and harbin. Nutrients. https://doi.org/10.3390/nu11010201

    Article  PubMed  PubMed Central  Google Scholar 

  84. Cashman KD (2015) Vitamin D. dietary requirements and food fortification as a means of helping achieve adequate vitamin D status. J Steroid Biochem Mol Biol 148:19–26

    CAS  PubMed  Google Scholar 

  85. Hayes A, Duffy S, O’Grady M, Jakobsen J, Galvin K, Teahan-Dillon J, Kerry J, Kelly A, O’Doherty J, Higgins S, Seamans KM, Cashman KD (2016) Vitamin D-enhanced eggs are protective of wintertime serum 25-hydroxyvitamin D in a randomized controlled trial of adults. Am J Clin Nutr 104:629–637

    CAS  PubMed  Google Scholar 

  86. Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, Erdman JW Jr, Kris-Etherton P, Goldberg IJ, Kotchen TA, Lichtenstein AH, Mitch WE, Mullis R, Robinson K, Wylie-Rosett J, St Jeor S, Suttie J, Tribble DL, Bazzarre TL (2000) AHA Dietary Guidelines. Revision 2000: a statement for healthcare professionals from the nutrition committee of the American Heart Association. Stroke 31:2715–2766

    Google Scholar 

  87. Duffy SK, Kelly AK, Rajauria G, Jakobsen J, Clarke LC, Monahan FJ, Dowling KG, Hull G, Galvin K, Cashman KD, Hayes A, O’Doherty JV (2018) The use of synthetic and natural vitamin D sources in pig diets to improve meat quality and vitamin D content. Meat Sci 143:60–68

    CAS  PubMed  Google Scholar 

  88. Duffy SK, O’Doherty JV, Rajauria G, Clarke LC, Hayes A, Dowling KG, O’Grady MN, Kerry JP, Jakobsen J, Cashman KD, Kelly AK (2018) Vitamin D-biofortified beef: a comparison of cholecalciferol with synthetic versus UVB-mushroom-derived ergosterol as feed source. Food Chem 256:18–24

    CAS  PubMed  Google Scholar 

  89. Duffy SK, O’Doherty JV, Rajauria G, Clarke LC, Cashman KD, Hayes A, O’Grady MN, Kerry JP, Kelly AK (2017) Cholecalciferol supplementation of heifer diets increases beef vitamin D concentration and improves beef tenderness. Meat Sci 134:103–110

    CAS  PubMed  Google Scholar 

  90. Graff IE, Øyen J, Kjellevold M, Frøyland L, Gjesdal CG, Almås B, Rosenlund G, Lie Ø (2016) Reduced bone resorption by intake of dietary vitamin D and K from tailor-made Atlantic salmon: a randomized intervention trial. Oncotarget 7:69200–69215

    PubMed  PubMed Central  Google Scholar 

  91. EFSA FEEDAP Panel (EFSA Panel on Additives and Products or Substances used in Animal Feed), Rychen G, Aquilina G, Azimonti G, Bampidis V, Bastos ML, Bories G, Chesson A, Cocconcelli PS, Flachowsky G, Gropp J, Kolar B, Kouba M, López‐Alonso M, López Puente S, Mantovani A, Mayo B, Ramos F, Saarela M, Villa RE, Wester P, Costa LG, Dierick N, Manini P, Tarrés‐Call J and Wallace RJ (2017) Scientific opinion on the safety of vitamin D3 addition to feedingstuffs for fish. EFSA J 15(3):4713

  92. Itkonen ST, Skaffari E, Saaristo P, Saarnio EM, Erkkola M, Jakobsen J, Cashman KD, Lamberg-Allardt C (2016) Effects of vitamin D2-fortified bread v. supplementation with vitamin D2 or D3 on serum 25-hydroxyvitamin D metabolites: an 8-weekrandomised-controlled trial in young adult Finnish women. Br J Nutr 115:1232–1239

    CAS  PubMed  Google Scholar 

  93. EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies) (2015) Scientific Opinion on the safety of UV-treated bread as a novel food. EFSA J. https://doi.org/10.2903/j.efsa.2015.4148

    Article  Google Scholar 

  94. Cashman KD, Kiely M, Seamans KM, Urbain P (2016) Effect of ultraviolet light-exposed mushrooms on vitamin D status: liquid chromatography-tandem mass spectrometry reanalysis of bio banked sera from a randomized controlled trial and a systematic review plus meta-analysis. J Nutr 146:565–575

    CAS  PubMed  Google Scholar 

  95. ODIN project website (2018) Vitamin D map. http://www.odin-vitd.eu/files/vit%20D%20winter%20map%20landscape%20new.pdf. Accessed Dec 5, 2018

  96. Urbain P, Valverde J, Jakobsen J (2016) Impact on vitamin D2, vitamin D4 and Agaritine in Agaricus bisporus mushrooms after artificial and natural solar UV light exposure. Plant Foods Hum Nutr 71:314–321

    CAS  PubMed  Google Scholar 

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  1. Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland

    Kevin D. Cashman

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Cashman, K.D. Vitamin D Deficiency: Defining, Prevalence, Causes, and Strategies of Addressing. Calcif Tissue Int 106, 14–29 (2020). https://doi.org/10.1007/s00223-019-00559-4

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